Provider Demographics
NPI:1073055596
Name:HENRY, MINDY NICOLE (MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:NICOLE
Last Name:HENRY
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 W 27TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1433
Mailing Address - Country:US
Mailing Address - Phone:713-869-4956
Mailing Address - Fax:713-869-5053
Practice Address - Street 1:1740 W 27TH ST STE 207
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1433
Practice Address - Country:US
Practice Address - Phone:713-869-4956
Practice Address - Fax:713-869-5053
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131738363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114914801Medicaid